John P Bolger PHD LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

1237 Issued in SC

Legal business name

JOHN P BOLGER PHD LLC

Practice address

1305 Wild Olive Dr
Mt Pleasant, SC 29464-7478

Phone

(910) 987-7285

NPI assigned

Jun 20, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John P Bolger, PH.D.NPI 1891725024

Title

Sole Owner

Phone

(910) 987-7285

Specialties & licenses 4

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John P Bolger, PH.D.

  • Clinical Neuropsychologist
  • Mount Pleasant, SC
  • NPI 1891725024
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434758400000",
    "number": "1710369236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 WILD OLIVE DR",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294647478",
            "telephone_number": "910-987-7285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 WILD OLIVE DR",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294647478",
            "telephone_number": "910-987-7285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN P BOLGER PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-20",
        "last_updated": "2015-06-20",
        "status": "A",
        "authorized_official_last_name": "BOLGER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "910-987-7285",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "SC",
            "license": "1237",
            "primary": true
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "SC",
            "license": "1237",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "SC",
            "license": "1237",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Health",
            "state": "SC",
            "license": "1237",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Mount Pleasant, SC
• Providers in Mount Pleasant, SC by specialty
• Clinical Neuropsychologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.